@phdthesis{Yin2023, author = {Yin, Jing}, title = {Progressive alterations of pro- and antidegeneration markers in the nigrostriatal tract of the AAV1/2-A53T-α synuclein rat model of Parkinson's disease}, doi = {10.25972/OPUS-26064}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260645}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Neurodegeneration plays an essential role in Parkinson's disease (PD). Several crucial neuronal pro-and antidegeneration markers were described to be altered in disease models accompanied by neurodegeneration. In the AAV1/2-A53T-aSyn PD rat model progressive time-dependent motor impairment and neurodegeneration in the nigrostriatal tract starting from 2 weeks after PD model induction could be found. Downregulation of Nrf2 in SN and nigrostriatal axon localization, a trend of Tau downregulation in SN and upregulation in axon localization in the AAV1/2-A53T-aSyn PD rat model were observed, indicating potential therapeutic value of these two molecular targets in PD. No alterations of SARM1 and NMNAT2 could be detected, indicating little relevance of these two molecules with our AAV1/2-A53T-aSyn rat model.}, language = {en} } @phdthesis{Bohr2022, author = {Bohr, Arne}, title = {{\"U}ber den Einfluss einer kontinuierlichen tiefen Hirnstimulation des pedunkulopontinen tegmentalen Nucleus auf motorische Defizite in einem Ratten-Schlaganfallmodell}, publisher = {Current Neurovascular Research}, doi = {10.25972/OPUS-27187}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-271876}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Bei einem isch{\"a}mischen Schlaganfall bestehen neben dem Verlust von neuronalen Zellen auch dysfunktionale Signale, die sich pathologisch auf die tieferen motorischen Zentren des zentralen Nervensystems auswirken k{\"o}nnen. Mittels tiefer Hirnstimulation kann die Weiterleitung pathologischer Signale im Bereich des neuronalen Netzwerks unterbrochen werden. In dieser Arbeit wurde ein Tiermodell verwendet, in welchem bei insgesamt 18 Ratten ein photothrombotischer Schlaganfall des rechten sensomotorischen Kortex induziert wurde. Nachdem bei jedem Tier eine Mikroelektrode in den Bereich des pedunkulopontinen tegmentalen Nucleus implantiert worden war, wurde eine kontinuierliche tiefe Hirnstimulation {\"u}ber 10 Tage durchgef{\"u}hrt. Die Gegen{\"u}berstellung der Fall- und Kontrollgruppe im Beam-Walking- und Ladder-Rung-Walking-Test ergab hierbei keine Verbesserung der motorischen Defizite durch die Intervention. Das Ergebnis l{\"a}sst sich vor dem Hintergrund neuerer Erkenntnisse einordnen, nach welchen der pedunkulopontine tegmentale Nucleus nicht f{\"u}r die Bewegungsinitiierung verantwortlich ist.}, subject = {Schlaganfall}, language = {de} } @phdthesis{Hochheimer2022, author = {Hochheimer, Vanessa Christine}, title = {Of cells and enzymes: How dermal fibroblasts can impact pain in Fabry Disease and Why looking at the 3D-structure of α-Galactosidase A may be worthwhile for clinical management of Fabry patients}, doi = {10.25972/OPUS-29660}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-296607}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Fabry Disease (FD) is a genetic lysosomal storage disorder based on mutations in the gene encoding α-Galactosidase A (α-GalA) leading to accumulation of globotriaosylceramide (Gb3). Missense mutations induce an amino acid exchange (AAE) in the α-GalA. Pain is a predominant symptom in FD and the pathophysiology is unclear. Skin punch biopsies were obtained from 40 adult FD patients and ten healthy controls and dermal fibroblast cultures were generated for cell culture experiments to investigate Gb3 load, gene and protein expression patterns and ion channel activity. The 3D-structure of α-GalA was downloaded into Pymol Graphics System and the AAE was depicted and located in order to investigate the correlation between the AAE location type in the α-GalA and the clinical FD phenotype. FD dermal fibroblasts showed high Gb3 load depending on treatment interval and expressed Kca1.1 channels. Activity was reduced in FD cells at baseline, but increased over-proportionately upon Gb3-cleavage by enzyme replacement therapy. Gene and protein expression of Kca1.1 was increased in FD cells. FD dermal fibroblasts showed higher gene expression of Notch1 and several cytokines. Further, it was shown that three different AAE location types can be differentiated: mutations in the active site ('active site'), those buried in the core of α-GalA ('buried') and those at another location, mostly on the protein surface ('other'). FD patients carrying active site or buried mutations showed a severe clinical phenotype with multi-organ manifestation and early disease onset. Patients with other mutations were less severely affected with oligo-organ manifestation sparing the nervous system and later disease onset. These results show that dermal fibroblasts may be involved in FD-associated pain and that stratification of FD patients carrying missense mutations by AAE location type may be an advantageous parameter that can help in the management of FD patients.}, subject = {Fabry-Krankheit}, language = {en} } @phdthesis{Grohmann2023, author = {Grohmann, Christoph}, title = {Kognitive Leistungsf{\"a}higkeit und Lebensqualit{\"a}t bei minimaler hepatischer Enzephalopathie - eine Pilotstudie zum Patient Reported Outcome in der Verlaufsdiagnostik}, doi = {10.25972/OPUS-30537}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-305375}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Die WHO definiert Gesundheit als v{\"o}lliges k{\"o}rperliches, geistiges und soziales Wohlbefinden. W{\"a}hrend diese ganzheitliche Betrachtungsweise seit Menschengedenken nahezu weltweit das Gesundheitswesen pr{\"a}gt, hat die Medizin in Europa mit der naturwissenschaftlichen Erkenntnisrevolution einen Sonderweg eingeschlagen. Hier wird der kranke Organismus in erster Linie als defekter Apparat gesehen, der mit ausgekl{\"u}gelter Technik zu reparieren ist. Aber auch pr{\"a}ziseste Qualit{\"a}tsarbeit st{\"o}ßt dabei oft an Leistungsgrenzen, weil sie als seelenlos erlebt wird. Daher sehen heute viele Fachgebiete die Notwendigkeit, ihre Behandlungskonzepte zu beseelen und ihre Behandlungserfolge auch anhand der subjektiv von Patienten empfundenen Lebensqualit{\"a}t zu beurteilen. F{\"u}r die Ermittlung dieses PRO kommen etablierte psychometrische Testverfahren in Frage, die sich auch f{\"u}r routinem{\"a}ßige Verlaufskontrollen eignen. In der vorliegenden Arbeit wurde am Beispiel der mHE gepr{\"u}ft, welchen Nutzen eine PRO-Bestimmung bei der Verlaufskontrolle haben kann. Dazu wurde eine prospektive Studie mit anf{\"a}nglich 75 Patienten durchgef{\"u}hrt. Alle hatten eine mHE und waren entweder alkoholbedingt oder aus anderen Gr{\"u}nden schwer leberkrank. An vier Terminen im Abstand von sechs Monaten wurden die kognitive Leistungsf{\"a}higkeit und der emotionale Status {\"u}berpr{\"u}ft. Die Patienten zeigten anf{\"a}nglich kognitive Einschr{\"a}nkungen, die sich im Verlauf der individuell abgestimmten Behandlung deutlich verbesserten oder ganz verschwanden. Die globale Testung mit dem MoCA ergab eine hochsignifikante Normalisierung im ersten Behandlungsjahr. Die MoCA-Werte am Studienanfang und -ende waren von der Erkrankungsursache unabh{\"a}ngig. Dieser Befund differenzierte sich in den Spezialtests TMT, PHES und NHPT. Hier zeigten die alkoholbedingt Erkrankten durchweg schlechtere Leistungen als die nicht-alkoholbedingt Erkrankten, erholten sich aber in der Regel auch deutlicher. Die seelische Gestimmtheit gem{\"a}ß BDI-II und die mit dem SF-36 MCS ermittelte psychosoziale Befindlichkeit waren in beiden Patientengruppen von Anfang an vergleichsweise g{\"u}nstig. Dabei hatten die alkoholbedingt Erkrankten die besseren Werte, speziell der BDI-II zeigte bei ihnen nach einem halben Jahr eine zus{\"a}tzliche und bleibende Stimmungsaufhellung an. Der SF-36 PCS zum K{\"o}rpererleben zeigte hingegen, dass sich die alkoholbedingt Erkrankten zu Studienbeginn in einer deutlich schlechteren Verfassung befanden. Diese verbesserte sich aber kontinuierlich, sodass nach 1,5 Jahren kein Unterschied mehr zu den nicht-alkoholbedingt Erkrankten bestand. Aus diesen Befunden und dem reichhaltigen Erfahrungsgut zur Alkoholkrankheit wird geschlossen, dass der Genesungsprozess bei alkoholbedingtem Leberversagen viel komplexer ist als bei nicht-alkoholbedingtem Leberversagen. Er k{\"o}nnte wesentlich mehr Zeit erfordern und wird offensichtlich anders erlebt. Dieser Patientengruppe k{\"o}nnten besondere physio- und gespr{\"a}chstherapeutische Angebote eine große Hilfe sein. Die Arbeit zeigt, dass es m{\"o}glich ist, mit wenig Aufwand komplement{\"a}r zu den klinischen Verlaufsbefunden einen informativen PRO-Bericht zu erhalten. Er hilft Angeh{\"o}rigen und medizinischem Personal, die pers{\"o}nlichen N{\"o}te und Hoffnungen der Patienten besser zu verstehen und gegebenenfalls einen Korrekturbedarf im Umgang zu erkennen. Hinzu kam im vorliegenden Fall die Erkenntnis, dass die alkoholbedingt Erkrankten in ihrem Kranksein anders betroffen waren. Die Gr{\"u}nde daf{\"u}r sind im Nachhinein plausibel, der Sachverhalt als solcher w{\"a}re aber ohne diese Spezialuntersuchung wohl nicht erkannt worden. Das Beispiel der PRO-Ermittlung bei der mHE macht den praktischen Wert einer Ber{\"u}cksichtigung des gesamtheitlichen Gesundheitskonzepts der WHO auch in der technikzentrierten „westlichen Medizin" deutlich.}, subject = {Encephalopathia hepatica}, language = {de} } @phdthesis{Zeumer2023, author = {Zeumer, Karolina}, title = {Die Rolle dendritischer Zellen beim isch{\"a}mischen Schlaganfall}, doi = {10.25972/OPUS-30258}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-302580}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Ziel dieser Studie war es, zu untersuchen, ob dendritische Zellen eine Rolle beim isch{\"a}mischen Schlaganfall spielen. Zur Beantwortung dieser Fragestellung wurde ein Mausmodell gew{\"a}hlt, in dem es nach Administration von Diphterietoxin zur selektiven Depletion CD11c positiver Zellen kommt (C.FVB-Tg(Itgax-DTR/EGFP)57Lan/J). Hierbei wird der Diphterietoxinrezeptor unter dem CD11c Promotor (ITGAX) exprimiert. Aufgrund der Wiederherstellung dendritischer Zellen nach ca. 24 Stunden waren wiederholte Applikationen von Diphterietoxin notwendig. Die Zusammensetzung anderer Immunzellen wurde dabei im Wesentlichen nicht ge{\"a}ndert. F{\"u}r eine Schlaganfallinduktion wurde eine tMCAO (transient middle cerebral artery occlusion) durchgef{\"u}hrt. Hierbei wird durch Okklusion der A. cerebri media mittels Verschlussfilament f{\"u}r 30 oder 60 Minuten ein Schlaganfall im Mediastromgebiet induziert. Es wurden unterschiedliche Verschlusszeiten, Zeitpunkte und Depletionsraten untersucht. In keinem der Versuchsans{\"a}tze kam es zu einer signifikanten Ver{\"a}nderung des Schlaganfallvolumens nach Depletion CD11c positiver Zellen. Mittels quantitativer real-time PCR wurde die Expression unterschiedlicher Zytokine nach tMCAO und CD11c-Depletion untersucht. An Tag 1 nach Schlaganfallinduktion und hoher Depletionsrate ergab sich eine Verminderung der Expression von IL-1β und IL-6, w{\"a}hrend an Tag 3 und niedriger Depletionsrate die Expression dieser Zytokine nach CD11c-Depletion zunahm. Grund hierf{\"u}r k{\"o}nnte die Expression dieser Zytokine durch andere Zellen des Immunsystems, wie etwa neutrophile Granulozyten oder Mikroglia/Makrophagen sein, die m{\"o}glicherweise einer regulatorischen Funktion durch die Interaktion von Dendritischen Zellen und regulatorischen T-Zellen unterliegen. Weitere experimentelle Ans{\"a}tze sind notwendig, um diese Fragestellung beantworten zu k{\"o}nnen. TGF-β zeigte durchgehend in allen Versuchsanordnungen eine verminderte Expression nach der Depletion dendritischer Zellen. Es ist naheliegend, dass dieses neuroprotektiv-regulatorische Zytokin direkt einer Produktion durch dendritische Zellen oder von nachfolgend aktivierten T-Zellen unterliegt. In immunhistochemischen Studien konnte des Weiteren keine {\"A}nderung des Immigrationsverhaltens von CD11b+ Zellen ins Gehirn gesehen werden. Diese Studie unterliegt jedoch einigen Limitationen. So stellte sich im Laufe der Experimente heraus, dass die wiederholte Applikation von Diphterietoxin zu einer erh{\"o}hten Mortalit{\"a}t der Versuchstiere f{\"u}hrte. Nach Fertigstellung der Experimente erschien hierzu eine Publikation, welche die wiederholte Administration von DTX und die Entwicklung einer Myokarditis im gew{\"a}hlten Mausmodell in Zusammenhang brachte.}, subject = {Schlaganfall}, language = {de} } @phdthesis{Ostertag2023, author = {Ostertag, Viktoria Charlotte Caroline}, title = {Pr{\"a}ventive und therapeutische Behandlung mit einem CSF-1-Rezeptorinhibitor bei verschiedenen Charcot-Marie-Tooth Mausmodellen}, doi = {10.25972/OPUS-30852}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308528}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Die Charcot-Marie-Tooth-Neuropathie umfasst eine heterogene Gruppe von erblichen unter anderem demyelinisierenden Erkrankungen des peripheren Nervensystems. Trotz ihrer hohen Pr{\"a}valenz von 1:2.500 gibt es bis dato keine kausalen Therapiem{\"o}glichkeiten. Durch den progressiven Krankheitsverlauf wird die Lebensqualit{\"a}t der Patienten stetig gemindert; der fortschreitende Verlust der Muskelkraft und St{\"o}rungen des Gangbildes sind besonders belastend. Urs{\"a}chlich f{\"u}r die CMT1-Neuropathie sind unter anderem Mutationen in Genen, die f{\"u}r Molek{\"u}le des Myelins von Schwannzellen codieren. Diese Mutationen f{\"u}hren zu einer verminderten Stabilit{\"a}t und Funktion des Myelins und so letzten Endes zu einer Demyelinisierung und axonalen Sch{\"a}digung der peripheren Nerven. Weitere Studien in CMT1-Mausmodellen zeigten jedoch, dass nicht nur die verringerte Myelinstabilit{\"a}t sondern auch eine durch das Immunsystem vermittelte geringgradige Entz{\"u}ndungsreaktion f{\"u}r die Symptome urs{\"a}chlich sein k{\"o}nnte. Hier spielen vor allem Makrophagen eine zentrale Rolle. Das Zytokin CSF-1 aktiviert die Makrophagen und verursacht so eine Demyelinisierung der peripheren Nerven. In P0het und Cx32def Mausmodellen konnte nachgewiesen werden, dass eine medikament{\"o}se Inhibition des CSF-1-Rezeptors an Makrophagen zu einem verbesserten Nervph{\"a}notypen und einer deutlichen Abmilderung des Krankheitsbildes f{\"u}hrte. In dieser Arbeit wurden in P0het und Cx32def Mausmodellen weiterf{\"u}hrende Behandlungsstudien mit einem CSF-1-RI durchgef{\"u}hrt, die untersuchen, zu welchem Zeitpunkt innerhalb des Krankheitsverlaufs (therapeutisch oder pr{\"a}ventiv) eine erfolgreiche Therapie noch m{\"o}glich ist und ob bei einem fr{\"u}heren Beginn eine noch bessere Wirkung erzielt werden kann. Abh{\"a}ngig von den verschiedenen Start- und Endpunkten waren unterschiedliche Ergebnisse zu beobachten: Hinsichtlich der klinischen Parameter wie der Greifkraft und der Anzahl an abnormal innervierten Synapsen zeigten die Tiere im pr{\"a}ventiven Behandlungszweig in beiden Mausmodellen das beste Ergebnis im Vergleich zu den Kontrolltieren. Diese substantielle Verbesserung ließ sich unabh{\"a}ngig von einem Makrophagen-Reflux sogar noch 6 Monate nach Behandlungsabbruch nachweisen. Bez{\"u}glich der endoneuralen Makrophagendepletion war sowohl in den P0het als auch den Cx32def Tieren im pr{\"a}ventiven sowie im therapeutischen Behandlungszweig eine signifikante Verbesserung zu beobachten. Diese Ergebnisse heben ein weiteres Mal die Bedeutung der Makrophagen als Teil einer Entz{\"u}ndungsreaktion in der Pathogenese der CMT1-Neuropathie hervor. Des Weiteren konnte die These gefestigt werden, dass eine Inhibition des CSF-1-Rezeptors zu verbesserten histopathologischen sowie funktionellen Parametern f{\"u}hrt. Um ein gutes Ansprechen auf die Therapie zu erzielen, m{\"u}ssen ein m{\"o}glichst fr{\"u}her Therapiebeginn sowie eine nachhaltige Behandlungsdauer gew{\"a}hrleistet sein.}, subject = {Charcot-Marie-Syndrom}, language = {de} } @article{AsterEvdokimovBraunetal.2022, author = {Aster, H-C and Evdokimov, D. and Braun, A. and {\"U}{\c{c}}eyler, N. and Sommer, C.}, title = {Analgesic Medication in Fibromyalgia Patients: A Cross-Sectional Study}, series = {Pain Research and Management}, volume = {2022}, journal = {Pain Research and Management}, doi = {10.1155/2022/1217717}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300578}, year = {2022}, abstract = {There is no approved drug for fibromyalgia syndrome (FMS) in Europe. In the German S3 guideline, amitriptyline, duloxetine, and pregabalin are recommended for temporary use. The aim of this study was to cross-sectionally investigate the current practice of medication in FMS patients in Germany. We systematically interviewed 156 patients with FMS, while they were participating in a larger study. The patients had been stratified into subgroups with and without a decrease in intraepidermal nerve fiber density. The drugs most commonly used to treat FMS pain were nonsteroidal anti-inflammatory drugs (NSAIDs) (41.0\% of all patients), metamizole (22.4\%), and amitriptyline (12.8\%). The most frequent analgesic treatment regimen was "on demand" (53.9\%), during pain attacks, while 35.1\% of the drugs were administered daily and the remaining in other regimens. Median pain relief as self-rated by the patients on a numerical rating scale (0-10) was 2 points for NSAIDS, 2 for metamizole, and 1 for amitriptyline. Drugs that were discontinued due to lack of efficacy rather than side effects were acetaminophen, flupirtine, and selective serotonin reuptake inhibitors. Reduction in pain severity was best achieved by NSAIDs and metamizole. Our hypothesis that a decrease in intraepidermal nerve fiber density might represent a neuropathic subtype of FMS, which would be associated with better effectiveness of drugs targeting neuropathic pain, could not be confirmed in this cohort. Many FMS patients take "on-demand" medication that is not in line with current guidelines. More randomized clinical trials are needed to assess drug effects in FMS subgroups.}, language = {en} } @article{KressEgenolfSommeretal.2023, author = {Kreß, Luisa and Egenolf, Nadine and Sommer, Claudia and {\"U}{\c{c}}eyler, Nurcan}, title = {Cytokine expression profiles in white blood cells of patients with small fiber neuropathy}, series = {BMC Neuroscience}, volume = {24}, journal = {BMC Neuroscience}, number = {1}, doi = {10.1186/s12868-022-00770-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300619}, year = {2023}, abstract = {Background The role of cytokines in the pathophysiology, diagnosis, and prognosis of small fiber neuropathy (SFN) is incompletely understood. We studied expression profiles of selected pro- and anti-inflammatory cytokines in RNA from white blood cells (WBC) of patients with a medical history and a clinical phenotype suggestive for SFN and compared data with healthy controls. Methods We prospectively recruited 52 patients and 21 age- and sex-matched healthy controls. Study participants were characterized in detail and underwent complete neurological examination. Venous blood was drawn for routine and extended laboratory tests, and for WBC isolation. Systemic RNA expression profiles of the pro-inflammatory cytokines interleukin (IL)-1ß, IL-2, IL-8, tumor necrosis factor-alpha (TNF) and the anti-inflammatory cytokines IL-4, IL-10, transforming growth factor beta-1 (TGF) were analyzed. Protein levels of IL-2, IL-8, and TNF were measured in serum of patients and controls. Receiver operating characteristic (ROC)-curve analysis was used to determine the accuracy of IL-2, IL-8, and TNF in differentiating patients and controls. To compare the potential discriminatory efficacy of single versus combined cytokines, equality of different AUCs was tested. Results WBC gene expression of IL-2, IL-8, and TNF was higher in patients compared to healthy controls (IL-2: p = 0.02; IL-8: p = 0.009; TNF: p = 0.03) and discriminated between the groups (area under the curve (AUC) ≥ 0.68 for each cytokine) with highest diagnostic accuracy reached by combining the three cytokines (AUC = 0.81, sensitivity = 70\%, specificity = 86\%). Subgroup analysis revealed the following differences: IL-8 and TNF gene expression levels were higher in female patients compared to female controls (IL-8: p = 0.01; TNF: p = 0.03). The combination of TNF with IL-2 and TNF with IL-2 and IL-8 discriminated best between the study groups. IL-2 was higher expressed in patients with moderate pain compared to those with severe pain (p = 0.02). Patients with acral pain showed higher IL-10 gene expression compared to patients with generalized pain (p = 0.004). We further found a negative correlation between the relative gene expression of IL-2 and current pain intensity (p = 0.02). Serum protein levels of IL-2, IL-8, and TNF did not differ between patients and controls. Conclusions We identified higher systemic gene expression of IL-2, IL-8, and TNF in SFN patients than in controls, which may be of potential relevance for diagnostics and patient stratification.}, language = {en} } @article{LorenzMusacchioKunstmannetal.2022, author = {Lorenz, Delia and Musacchio, Thomas and Kunstmann, Erdmute and Grauer, Eva and Pluta, Natalie and Stock, Annika and Speer, Christian P. and Hebestreit, Helge}, title = {A case report of Sanfilippo syndrome - the long way to diagnosis}, series = {BMC Neurology}, volume = {22}, journal = {BMC Neurology}, number = {1}, doi = {10.1186/s12883-022-02611-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300465}, year = {2022}, abstract = {Background Mucopolysaccharidosis type III (Sanfilippo syndrome) is a lysosomal storage disorder, caused by a deficiency in the heparan-N-sulfatase enzyme involved in the catabolism of the glycosaminoglycan heparan sulfate. It is characterized by early nonspecific neuropsychiatric symptoms, followed by progressive neurocognitive impairment in combination with only mild somatic features. In this patient group with a broad clinical spectrum a significant genotype-phenotype correlation with some mutations leading to a slower progressive, attenuated course has been demonstrated. Case presentation Our patient had complications in the neonatal period and was diagnosed with Mucopolysaccharidosis IIIa only at the age of 28 years. He was compound heterozygous for the variants p.R245H and p.S298P, the latter having been shown to lead to a significantly milder phenotype. Conclusions The diagnostic delay is even more prolonged in this patient population with comorbidities and a slowly progressive course of the disease.}, language = {en} } @article{KraftFleischerWiedmannetal.2017, author = {Kraft, Peter and Fleischer, Anna and Wiedmann, Silke and R{\"u}cker, Viktoria and Mackenrodt, Daniel and Morbach, Caroline and Malzahn, Uwe and Kleinschnitz, Christoph and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Feasibility and diagnostic accuracy of point-of-care handheld echocardiography in acute ischemic stroke patients - a pilot study}, series = {BMC Neurology}, volume = {17}, journal = {BMC Neurology}, number = {159}, doi = {10.1186/s12883-017-0937-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158081}, year = {2017}, abstract = {Background: Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting. Methods: IS patients were recruited on the SU of the University Hospital W{\"u}rzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF). Diagnostic agreement was assessed by comparing POC with SE executed by an expert sonographer, and intraclass correlation coefficient (ICC) or kappa (κ) with 95\% confidence intervals (95\% CI) were calculated. Results: In the 78 patients receiving both POC and SE agreement for cardiac parameters was good, with ICC varying from 0.82 (95\% CI 0.71-0.89) to 0.93 (95\% CI 0.87-0.96), and κ from 0.39 (-95\% CI 0.14-0.92) to 0.79 (95\% CI 0.67-0.91). Detection of systolic dysfunction with POC echocardiography compared to SE was very good, with an area under the curve of 0.99 (0.96-1.00). Interrater agreement for LVEF measured by POC echocardiography was good with κ 0.63 (95\% CI 0.40-0.85). Conclusions: POC echocardiography in a SU setting is feasible enabling reliable quantification of LVEF and preliminary assessment of selected cardiac parameters that might be used for research purposes. Its potential clinical utility in triaging stroke patients who should undergo or do not necessarily require SE needs to be investigated in larger prospective diagnostic studies.}, language = {en} } @article{EssigBabilonVollmuthetal.2021, author = {Essig, Fabian and Babilon, Lilith and Vollmuth, Christoph and Kollikowski, Alexander M. and Pham, Mirko and Solymosi, L{\´a}szl{\´o} and Haeusler, Karl Georg and Kraft, Peter and Stoll, Guido and Schuhmann, Michael K.}, title = {High mobility group box 1 protein in cerebral thromboemboli}, series = {International Journal of Molecular Sciences}, volume = {22}, journal = {International Journal of Molecular Sciences}, number = {20}, issn = {1422-0067}, doi = {10.3390/ijms222011276}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265568}, year = {2021}, abstract = {High-mobility group box 1 protein (HMGB1) is a damage-associated molecular pattern (DAMP) involved in neutrophil extracellular trap (NET) formation and thrombosis. NETs are regularly found in cerebral thromboemboli. We here analyzed associated HMGB1 expression in human thromboemboli retrieved via mechanical thrombectomy from 37 stroke patients with large vessel occlusion. HMGB1 was detected in all thromboemboli, accounting for 1.7\% (IQR 0.6-6.2\%) of the total thromboemboli area and was found to be colocalized with neutrophils and NETs and in spatial proximity to platelets. Correlation analysis revealed that the detection of HMGB1 was strongly related to the number of neutrophils (r = 0.58, p = 0.0002) and platelets (r = 0.51, p = 0.001). Our results demonstrate that HMGB1 is a substantial constituent of thromboemboli causing large vessel occlusion stroke.}, language = {en} } @article{KleinGrohYuanetal.2022, author = {Klein, Dennis and Groh, Janos and Yuan, Xidi and Berve, Kristina and Stassart, Ruth and Fledrich, Robert and Martini, Rudolf}, title = {Early targeting of endoneurial macrophages alleviates the neuropathy and affects abnormal Schwann cell differentiation in a mouse model of Charcot-Marie-Tooth 1A}, series = {Glia}, volume = {70}, journal = {Glia}, number = {6}, doi = {10.1002/glia.24158}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318714}, pages = {1100 -- 1116}, year = {2022}, abstract = {We have previously shown that targeting endoneurial macrophages with the orally applied CSF-1 receptor specific kinase (c-FMS) inhibitor PLX5622 from the age of 3 months onwards led to a substantial alleviation of the neuropathy in mouse models of Charcot-Marie-Tooth (CMT) 1X and 1B disease, which are genetically-mediated nerve disorders not treatable in humans. The same approach failed in a model of CMT1A (PMP22-overexpressing mice, line C61), representing the most frequent form of CMT. This was unexpected since previous studies identified macrophages contributing to disease severity in the same CMT1A model. Here we re-approached the possibility of alleviating the neuropathy in a model of CMT1A by targeting macrophages at earlier time points. As a proof-of-principle experiment, we genetically inactivated colony-stimulating factor-1 (CSF-1) in CMT1A mice, which resulted in lower endoneurial macrophage numbers and alleviated the neuropathy. Based on these observations, we pharmacologically ablated macrophages in newborn CMT1A mice by feeding their lactating mothers with chow containing PLX5622, followed by treatment of the respective progenies after weaning until the age of 6 months. We found that peripheral neuropathy was substantially alleviated after early postnatal treatment, leading to preserved motor function in CMT1A mice. Moreover, macrophage depletion affected the altered Schwann cell differentiation phenotype. These findings underscore the targetable role of macrophage-mediated inflammation in peripheral nerves of inherited neuropathies, but also emphasize the need for an early treatment start confined to a narrow therapeutic time window in CMT1A models and potentially in respective patients.}, language = {en} } @article{OezdağAcarlıKleinEgenolfetal.2022, author = {{\"O}zdağ Acarl{\i}, Ay{\c{s}}e Nur and Klein, Thomas and Egenolf, Nadine and Sommer, Claudia and {\"U}{\c{c}}eyler, Nurcan}, title = {Subepidermal Schwann cell counts correlate with skin innervation - an exploratory study}, series = {Muscle \& Nerve}, volume = {65}, journal = {Muscle \& Nerve}, number = {4}, doi = {10.1002/mus.27496}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318726}, pages = {471 -- 479}, year = {2022}, abstract = {Introduction/Aims Schwann cell clusters have been described at the murine dermis-epidermis border. We quantified dermal Schwann cells in the skin of patients with small-fiber neuropathy (SFN) compared with healthy controls to correlate with the clinical phenotype. Methods Skin punch biopsies from the lower legs of 28 patients with SFN (11 men, 17 women; median age, 54 [range, 19-73] years) and 9 healthy controls (five men, four women, median age, 34 [range, 25-69] years) were immunoreacted for S100 calcium-binding protein B as a Schwann cell marker, protein-gene product 9.5 as a pan-neuronal marker, and CD207 as a Langerhans cell marker. Intraepidermal nerve fiber density (IENFD) and subepidermal Schwann cell counts were determined. Results Skin samples of patients with SFN showed lower IENFD (P < .05), fewer Schwann cells per millimeter (P < .01), and fewer Schwann cell clusters per millimeter (P < .05) than controls. When comparing SFN patients with reduced (n = 13; median age, 53 [range, 19-73] years) and normal distal (n = 15, median age, 54 [range, 43-68] years) IENFD, the number of solitary Schwann cells per millimeter (p < .01) and subepidermal nerve fibers associated with Schwann cell branches (P < .05) were lower in patients with reduced IENFD. All three parameters correlated positively with distal IENFD (P < .05 to P < .01), whereas no correlation was found between Schwann cell counts and clinical pain characteristics. Discussion Our data raise questions about the mechanisms underlying the interdependence of dermal Schwann cells and skin innervation in SFN. The temporal course and functional impact of Schwann cell presence and kinetics need further investigation.}, language = {en} } @article{SchreglmannBurkeBatlaetal.2022, author = {Schreglmann, Sebastian R. and Burke, Derek and Batla, Amit and Kresojevic, Nikola and Wood, Nicholas and Heales, Simon and Bhatia, Kailash P.}, title = {Cerebellar and Midbrain Lysosomal Enzyme Deficiency in Isolated Dystonia}, series = {Movement Disorders}, volume = {37}, journal = {Movement Disorders}, number = {4}, doi = {10.1002/mds.28937}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318743}, pages = {875 -- 877}, year = {2022}, language = {en} } @article{SchreglmannBhatia2022, author = {Schreglmann, Sebastian R. and Bhatia, Kailash P.}, title = {HOPS-Associated Neurological Disorders: Lysosomal Dysfunction as an Emerging Concept Underlying Dystonia}, series = {Movement Disorders Clinical Practice}, volume = {9}, journal = {Movement Disorders Clinical Practice}, number = {4}, doi = {10.1002/mdc3.13405}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318736}, pages = {452 -- 453}, year = {2022}, language = {en} } @article{BellingerAltenmuellerVolkmann2017, author = {Bellinger, Daniel and Altenm{\"u}ller, Eckart and Volkmann, Jens}, title = {Perception of time in music in patients with Parkinson's disease - The processing of musical syntax compensates for rhythmic deficits}, series = {Frontiers in Neuroscience}, volume = {11}, journal = {Frontiers in Neuroscience}, doi = {10.3389/fnins.2017.00068}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-171805}, year = {2017}, abstract = {Objective: Perception of time as well as rhythm in musical structures rely on complex brain mechanisms and require an extended network of multiple neural sources. They are therefore sensitive to impairment. Several psychophysical studies have shown that patients with Parkinson's disease (PD) have deficits in perceiving time and rhythms due to a malfunction of the basal ganglia (BG) network. Method: In this study we investigated the time perception of PD patients during music perception by assessing their just noticeable difference (JND) in the time perception of a complex musical Gestalt. We applied a temporal discrimination task using a short melody with a clear beat-based rhythm. Among the subjects, 26 patients under L-Dopa administration and 21 age-matched controls had to detect an artificially delayed time interval in the range between 80 and 300 ms in the middle of the musical period. We analyzed the data by (a) calculating the detection threshold directly, (b) by extrapolating the JNDs, (c) relating it to musical expertise. Results: Patients differed from controls in the detection of time-intervals between 220 and 300 ms (*p = 0.0200, n = 47). Furthermore, this deficit depended on the severity of the disease (*p = 0.0452; n = 47). Surprisingly, PD patients did not show any deficit of their JND compared to healthy controls, although the results showed a trend (*p = 0.0565, n = 40). Furthermore, no significant difference of the JND was found according to the severity of the disease. Additionally, musically trained persons seemed to have lower thresholds in detecting deviations in time and syntactic structures of music (*p = 0.0343, n = 39). Conclusion: As an explanation of these results, we would like to propose the hypothesis of a time-syntax-congruency in music perception suggesting that processing of time and rhythm is a Gestalt process and that cortical areas involved in processing of musical syntax may compensate for impaired BG circuits that are responsible for time processing and rhythm perception. This mechanism may emerge more strongly as the deficits in time processing and rhythm perception progress. Furthermore, we presume that top-down-bottom-up-processes interfere additionally and interact in this context of compensation.}, language = {en} } @article{FriedrichEldebakeyRoothansetal.2022, author = {Friedrich, Maximilian U. and Eldebakey, Hazem and Roothans, Jonas and Capetian, Philipp and Zwergal, Andreas and Volkmann, Jens and Reich, Martin}, title = {Current-dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto-interstitial pathway?}, series = {European Journal of Neurology}, volume = {29}, journal = {European Journal of Neurology}, number = {5}, doi = {10.1111/ene.15257}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318700}, pages = {1545 -- 1549}, year = {2022}, abstract = {Background and purpose The aim was to characterize a combined vestibular, ocular motor and postural syndrome induced by deep brain stimulation (DBS) of the subthalamic nucleus in a patient with Parkinson's disease. Methods In a systematic DBS programming session, eye, head and trunk position in roll and pitch plane were documented as a function of stimulation amplitude and field direction. Repeat ocular coherence tomography was used to estimate ocular torsion. The interstitial nucleus of Cajal (INC), zona incerta (ZI) and ascending vestibular fibre tracts were segmented on magnetic resonance imaging using both individual and normative structural connectomic data. Thresholded symptom-associated volumes of tissue activated (VTA) were calculated based on documented stimulation parameters. Results Ipsilateral ocular tilt reaction and body lateropulsion as well as contralateral torsional nystagmus were elicited by the right electrode in a current-dependent manner and subsided after DBS deactivation. With increasing currents, binocular tonic upgaze and body retropulsion were observed. Symptoms were consistent with an irritative effect on the INC. Symptom-associated VTA was found to overlap with the dorsal ZI and the ipsilateral vestibulothalamic tract, while lying rather distant to the INC proper. A ZI-to-INC 'incerto-interstitial' tract with contact to the medial-uppermost portion of the VTA could be traced. Conclusion Unilateral stimulation of INC-related circuitry induces an ipsilateral vestibular, ocular motor and postural roll-plane syndrome, which converts into a pitch-plane syndrome when functional activation expands bilaterally. In this case, tractography points to an incerto-interstitial pathway, a tract previously only characterized in non-human primates. Directional current steering proved useful in managing this rare side effect.}, language = {en} } @article{Sommer2022, author = {Sommer, Claudia}, title = {Natural course of Guillain-Barr{\´e} syndrome}, series = {European Journal of Neurology}, volume = {29}, journal = {European Journal of Neurology}, number = {10}, doi = {10.1111/ene.15498}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318757}, pages = {2881 -- 2882}, year = {2022}, language = {en} } @article{BadrMcFlederWuetal.2022, author = {Badr, Mohammad and McFleder, Rhonda L. and Wu, Jingjing and Knorr, Susanne and Koprich, James B. and H{\"u}nig, Thomas and Brotchie, Jonathan M. and Volkmann, Jens and Lutz, Manfred B. and Ip, Chi Wang}, title = {Expansion of regulatory T cells by CD28 superagonistic antibodies attenuates neurodegeneration in A53T-α-synuclein Parkinson's disease mice}, series = {Journal of Neuroinflammation}, volume = {19}, journal = {Journal of Neuroinflammation}, doi = {10.1186/s12974-022-02685-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300580}, year = {2022}, abstract = {Background Regulatory CD4\(^+\)CD25\(^+\)FoxP3\(^+\) T cells (Treg) are a subgroup of T lymphocytes involved in maintaining immune balance. Disturbance of Treg number and impaired suppressive function of Treg correlate with Parkinson's disease severity. Superagonistic anti-CD28 monoclonal antibodies (CD28SA) activate Treg and cause their expansion to create an anti-inflammatory environment. Methods Using the AAV1/2-A53T-α-synuclein Parkinson's disease mouse model that overexpresses the pathogenic human A53T-α-synuclein (hαSyn) variant in dopaminergic neurons of the substantia nigra, we assessed the neuroprotective and disease-modifying efficacy of a single intraperitoneal dose of CD28SA given at an early disease stage. Results CD28SA led to Treg expansion 3 days after delivery in hαSyn Parkinson's disease mice. At this timepoint, an early pro-inflammation was observed in vehicle-treated hαSyn Parkinson's disease mice with elevated percentages of CD8\(^+\)CD69\(^+\) T cells in brain and increased levels of interleukin-2 (IL-2) in the cervical lymph nodes and spleen. These immune responses were suppressed in CD28SA-treated hαSyn Parkinson's disease mice. Early treatment with CD28SA attenuated dopaminergic neurodegeneration in the SN of hαSyn Parkinson's disease mice accompanied with reduced brain numbers of activated CD4\(^+\), CD8\(^+\) T cells and CD11b\(^+\) microglia observed at the late disease-stage 10 weeks after AAV injection. In contrast, a later treatment 4 weeks after AAV delivery failed to reduce dopaminergic neurodegeneration. Conclusions Our data indicate that immune modulation by Treg expansion at a timepoint of overt inflammation is effective for treatment of hαSyn Parkinson's disease mice and suggest that the concept of early immune therapy could pose a disease-modifying option for Parkinson's disease patients.}, language = {en} } @article{DopplerSchusterAppeltshauseretal.2019, author = {Doppler, Kathrin and Schuster, Yasmin and Appeltshauser, Luise and Biko, Lydia and Villmann, Carmen and Weishaupt, Andreas and Werner, Christian and Sommer, Claudia}, title = {Anti-CNTN1 IgG3 induces acute conduction block and motor deficits in a passive transfer rat model}, series = {Journal of Neuroinflammation}, volume = {16}, journal = {Journal of Neuroinflammation}, number = {73}, doi = {10.1186/s12974-019-1462-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200476}, year = {2019}, abstract = {Background: Autoantibodies against the paranodal protein contactin-1 have recently been described in patients with severe acute-onset autoimmune neuropathies and mainly belong to the IgG4 subclass that does not activate complement. IgG3 anti-contactin-1 autoantibodies are rare, but have been detected during the acute onset of disease in some cases. There is evidence that anti-contactin-1 prevents adhesive interaction, and chronic exposure to anti-contactin-1 IgG4 leads to structural changes at the nodes accompanied by neuropathic symptoms. However, the pathomechanism of acute onset of disease and the pathogenic role of IgG3 anti-contactin-1 is largely unknown. Methods: In the present study, we aimed to model acute autoantibody exposure by intraneural injection of IgG of patients with anti-contacin-1 autoantibodies to Lewis rats. Patient IgG obtained during acute onset of disease (IgG3 predominant) and IgG from the chronic phase of disease (IgG4 predominant) were studied in comparison. Results: Conduction blocks were measured in rats injected with the "acute" IgG more often than after injection of "chronic" IgG (83.3\% versus 35\%) and proved to be reversible within a week after injection. Impaired nerve conduction was accompanied by motor deficits in rats after injection of the "acute" IgG but only minor structural changes of the nodes. Paranodal complement deposition was detected after injection of the "acute IgG". We did not detect any inflammatory infiltrates, arguing against an inflammatory cascade as cause of damage to the nerve. We also did not observe dispersion of paranodal proteins or sodium channels to the juxtaparanodes as seen in patients after chronic exposure to anti-contactin-1. Conclusions: Our data suggest that anti-contactin-1 IgG3 induces an acute conduction block that is most probably mediated by autoantibody binding and subsequent complement deposition and may account for acute onset of disease in these patients. This supports the notion of anti-contactin-1-associated neuropathy as a paranodopathy with the nodes of Ranvier as the site of pathogenesis.}, language = {en} }